Doctors Prefer not to Discuss End-of-Life Care with Heart Failure Patients
For patients who need end-of-life care, getting proper information about the medical steps involved is very important for the patient and his/her family. In a new study, researchers examined end-of-life care discussions between doctors and their heart failure patients. They found that doctors are reluctant to have this conversation due to several reasons, such as being uncomfortable bringing up the topic or believing that it was not their responsibility to have the discussion.
In this study, the researchers interviewed 50 physicians and 45 nurse practitioners or physician assistants. The medical professionals were from three practices at the Mayo Clinic and the Mayo Clinic Health System. The researchers found that only 12 percent of the clinicians carried out the routine end-of-life care conversation as recommended by the American Heart Association.
30 percent of the participants stated that they had little confidence in discussing or providing this kind of medical care. Overall, 52 percent of the clinicians reported feeling hesitant about broaching this subject. Out of this percentage, 21 percent felt that their patients were not ready for this conversation, 11 percent were uncomfortable about having this discussion, nine percent were worried about ruining the patient's hope and eight percent stated that they did not have time to talk about end-of-life care.
When the researchers asked the clinicians about who they believed should bring the subject up, 63 percent of heart failure specialists believed that heart failure cardiologists were responsible for this conversation. 58 percent of community cardiology clinicians felt the same way. On the other hand, 66 percent of primary care physicians believed that it was their responsibility.
"Providers did express an interest in receiving additional training to develop the skills and confidence to talk about end-of-life care with their patients with heart failure," said Shannon Dunlay, M.D., M.S., the study's lead researcher and a cardiologist at the Mayo Clinic in Rochester, MN.
She added, "Communication is key but in many hospitals and health systems this can be difficult as patients often have multiple healthcare providers. Sometimes it's helpful to pick up the phone and have a provider-to-provider conversation so that everybody is on the same page. Incorporating end-of-life conversations into the ongoing, routine care of the patient is important as goals and preferences can change over time and patients and their families can feel more comfortable and confident in relaying their wishes to multiple providers."
The findings were presented at the Quality of Care and Outcomes Research 2014 Scientific Sessions.